title: Suprapubic-assisted laparoendoscopic single-site surgery (LESS) in urology: our experience.
abstract: OBJECTIVE
  To report our experience with suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in urology.
  
  
  METHODS
  In all, 236 patients underwent SA-LESS A 5- and 10-mm (or two 5-mm) trocars were inserted at the medial margin of the umbilicus. A 10- or 5-mm trocar was inserted into the abdominal cavity below the ipsilateral pubic hairline. The technique for the SA-LESS is similar to that of the standard laparoscopy, with conventional instruments placed in the abdominal trocars, under direct vision achieved by a 10-mm conventional 30 ° or 5-mm flexible-tip 0 ° laparoscope placed through the trocar below the pubic hairline.
  
  
  RESULTS
  SA-LESS was successfully completed in 229 patients, without the need for ancillary trocars or additional instruments. Six patients required conversion to standard laparoscopy because of intraoperative bleeding (five) and failure to progress (one). One patient underwent open conversion because of gradual bleeding during the dissection of a dense adhesive renal pedicle due to infection and fibrosis The various SA-LESS procedures performed included adrenalectomy (15), renal cyst excision (19), nephrectomy (78; simple 63, radical 15), nephroureterectomy (three), nephron-sparing surgery (three), heminephroureterectomy (five), pyeloplasty (nine), pyelolithotomy (six), and ureterolithotomy (98). The median operative time was 81, 106, 92, 140, and 85 min, and the estimated blood loss was 60, 205, 115, 75, and 55 mL for adrenalectomy, simple nephrectomy, radical nephrectomy, pyeloplasty, and ureterolithotomy, respectively. At a mean (range) follow-up of 14.8 (2-27) months there was a hidden umbilicus scar. The scar below the pubic hairline was not detectable because of pubic hair covering.
  
  
  CONCLUSIONS
  SA-LESS appears to be feasible, safe and effective. Compared with umbilical LESS, the placement of a trocar at the umbilicus and below the pubic hairline not only decreases the difficulty of surgery but also leads to little postoperative pain and good cosmetic results.
authors.affiliation: Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China. gyfyurology@126.com
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Zou
authors.forename: Guoxi
authors.initials: G
authors.lastname: Zhang
authors.forename: Yijun
authors.initials: Y
authors.lastname: Xue
authors.forename: Yuanhu
authors.initials: Y
authors.lastname: Yuan
authors.forename: Rihai
authors.initials: R
authors.lastname: Xiao
authors.forename: Gengqing
authors.initials: G
authors.lastname: Wu
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Wang
authors.forename: Yuting
authors.initials: Y
authors.lastname: Wu
authors.forename: Dazhi
authors.initials: D
authors.lastname: Long
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.forename: Folin
authors.initials: F
authors.lastname: Liu
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult